5 Hard Questions EMS 2.0 Will Need to Address

“Success is to be measured not so much by the position that one has reached in life… as by the obstacles which he has overcome while trying to succeed.”

- Booker T. Washington

With multiple premiers of The Chronicles of EMS and a wave of enthusiasm from the EMS Today conference in Baltimore, the future of EMS looks bright, blindingly-bright. I’m incredibly optimistic about where this crazy experiment in EMS is headed, but I also see some big hurdles in our path.

Put on your shades and let’s talk about what I feel are the five biggest challenges to EMS reform.

1.) We’ve been talking a lot about unity and standardization, but individual EMS systems are unique in every way. How do you influence standardization and still allow for the tremendous leeway required for EMS agencies to be optimized for the communities that they serve? Can EMS agencies be different in geography, financial resources, administrative structure, culture, call volume, compensation and certification/education level and still find enough unity to advance the profession together?

Continue Reading…

Safe At Home

A good friend of mine is being sued by a former patient. I don’t know if that statement gives you anxiety the way it gives me anxiety. I’ll admit it, I have an underlying fear of having to defend myself and my actions in a court of law.

I’m not scared of being held accountable for the medical decisions I make. I feel that I tend to make fairly good decisions, thank you very much, but the legal process can be expensive. And let’s be honest…because this is just you and me talking right? Sometimes the right thing to do is far from clear.

In a court of law, everyone is allowed the benefit of months of preparation, and then days and weeks are spent mulling over decisions that were made in real time. In EMS, real time moves faster than you might think. And good, well meaning, experienced paramedics labor to do the right thing.

Continue Reading…

The February EMS Roundup

In the coldest February, as in every other month in every other year, the best thing to hold on to in this world is each other.

                    – Linda Ellerbee (American Journalist)

And what better way to bring the EMS world together than the Internet? February was full of news and fun at The Spot. I hid inside from the Colorado cold and wrote about how to set up an IV line firefighter style. I asked you if you knew what was in the last issue of Splatter. (If you subscribed you’d know!) We discussed tips for mastering the head-to-toe assessment and getting people to hang up their cell phones. The premier of The Chronicles of EMS was the coolest thing is the blogging world. And we explored credibility and redundancy before launching into two posts on hypothermia. (Specifically how to assess it and how to treat it.) Then we wrapped up with a few musings about what it means to be passionate and what it’s like to be a firefighter. My fingers bleed for you.

Continue Reading…

I’m A Firefighter

I don’t know if you knew that. It’s entirely possible that you missed it on the about page. If it seems strange that a firefighter would create a blog called The EMT Spot, consider that the fire service employs more EMTs than any other agency or industry. (Including private ambulance service.)

I didn’t begin my career as a firefighter but I’ll certainly end my career as one. I think I always knew that was the case. I’m a firefighter for a lot of good reasons.

I’m a firefighter because I believe in the honor, the history and the tradition of the American Fire Service.

Continue Reading…

Responding to Hypothermia

Part 2 of a 2 part series. (Part one is here.)

In our last post we looked at some of the causes of hypothermia, both typical and atypical. Then we talked a bit about the recognition of the hypothermia progression and what patients might look, feel and act like as they progress through their hypothermic condition.

Now let’s look at some of the guidelines for treating our hypothermia victims.

On the surface, treating hypothermia might seem deceptively simple. The treatment of mild hypothermia often is simple. Bring them in, stop the cooling and rewarm them. But as we progress into moderate and severe hypothermia, things get more complicated. Here are 12 guidelines to consider when the patient is more than just a little chilled.

Continue Reading…

What is Hypothermia Anyway?

Part 1 of a 2 part series. (Part two is here.)

We all understand that hypothermia occurs when the patients core temperature drops secondary to exposure to cold. But, clinically, what is hypothermia really? What happens to the body as it cools down and struggles to maintain its core temperature? Can we predict a patient’s relative core temperature based on our physical findings? Is treatment really as simple as bringing them in and warming them up?

Let’s review the basics of the hypothermia progression and explore how to treat these sometimes challenging patient presentations. Put your mittens on, this is a chilly ride.

Continue Reading…

How To Get Them to Hang-Up The Cell Phone

I want to share with you a quick technique I’ve been experimenting with for the past few years. I first came up with this while working as a supervisor in the private ambulance service. At that point I did a lot more interacting with bystanders on scene and it was often a challenge to get them to hang-up their cell phones and talk to me.

It still happens. And it seems that it’s becoming a more and more frequent event. People wreak their cars or fall down the escalator and their first thought is, “Oh my gosh, who’s going to pick up the kids at day care? What will my husband say?” And by the time we arrive, three to eight minutes later, they have their cell phone planted in their ear and the conversation is just getting under way. Does this happen to you to? I imagine it does.

Continue Reading…

How To Set Up An IV Line – Firefighter Style

You’ve been there before. You’re getting ready to start an IV. You pull out the necessary supplies, you hand off the IV bag and drip set to a nearby firefighter and he (or she) looks back at you a bit sheepishly. “I’ve never really been any good at setting these things up right” they say.

Let me tell you the down and dirty truth, strait from a firefighter. No self-respecting firefighter should be unable to set up an IV line.  Say what you will about patient assessment, vital signs, or splinting a broken limb, but IV lines are hydrodynamics. We use IV’s to take a fluid and transport it from one place to another, delivering water from its source through a flexible hose to a destination. Does any of this sound familiar?

Moving water around is what firefighters do. The problem here is that someone, maybe even you, taught that firefighter how to strip out and set up that IV line and you made it sound like a medical procedure. You probably told Mr. or Mrs. firefighter that the parts to the IV set up were things like an IV bag a drip chamber and a roller clamp. You may have described the process something like this.

Continue Reading…

Do You Know?

What two significant things happened behind the scenes at The EMT Spot this month?

What two updates are coming to the site?

What the big controversy over pre-hospital intubation is all about?

What happened in Detroit and Toronto to create such a stir over response times?

What happened to 30% of UK medics last year?

What program in New Mexico has cut drunks in the ER in half?

What’s wrong with the 6 year old little boy in the EMT scenario challenge? Continue Reading…

The January EMS Roundup

“Every man should be born again on the first day of January. Start with a fresh page. Take up one hole more in the buckle if necessary, or let down one, according to circumstances; but on the first of January let every man gird himself once more, with his face to the front, and take no interest in the things that were and are past.”

                         Henry Ward Beecher, US Congregational Minister

Certainly January is a month to face the future. If Minister Beecher would allow us just one transgression, I’d like to look back, for one brief moment, at the month that was.

Continue Reading…